Equestrian Sports

Equestrian Sports
Sports Injuries: Mechanisms, Prevention, Treatment

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?EQUESTRIAN SPORTS
DAVID M. JENKINSON
SARAH W. JENKINSON

History
Biomechanics, Disciplines, and Diversity
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Racing: Flat Track, Steeplechase, and Harness
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Polo
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Rodeo and Western Riding
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English Riding
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Driving
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Miscellaneous Competition Events
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Recreational Activities
Epidemiology
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Age
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Sex
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Areas of Injury
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Types of Injury
Specific Injuries
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Neurologic Injuries (Head and Spinal Cord)
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Spine
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Pelvis
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Upper Extremities
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Lower Extremities
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Medical Issues
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Toxicology and Drugs
Safety and Conditioning
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Conditioning
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Skills and Knowledge
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Equipment
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Medical Services
Conclusions
Chapter References

There is no doubt that horse sports are extremely dangerous, particularly those involving riding or jumping at high speeds. Riders have long accepted accidents and injuries as ?part of the game,? and ?get right back on the horse that threw you? is the catchphrase. Accidents happen because each horse is an individual, with its own personality, and although the basic nature of horses remains the same, it can be markedly influenced (for good or ill) by handling and training. Accidents and injuries are more likely to occur if a rider of limited skill, ability, or knowledge is paired with a horse whose level of training or personality is beyond the rider's scope. If the rider is not wearing appropriate and safe attire, the results may be that much worse. It is only in the last few decades that books about horses and riding have done more than gloss over safety for the rider; previously, most information on injuries and accident prevention was dedicated to the welfare of the horse.
HISTORY
Before domestication, the horse was first used as a source of food, being hunted by Paleolithic humans some 25,000 years ago (1). Not long after domestication (2000 to 3000 bc), horses were used for war, and they continued to be valuable allies well into World War II. Training for war spawned many of the horse sports seen today. As early as 1450 bc, the Greeks introduced both horse racing with riders and chariot racing into the Olympic Games (1). These evolved into the horse racing events we know today?on the flat track (as in the Kentucky Derby), the steeplechase (over jumps), and harness racing. The competition known as 3-day eventing (or ?combined training?) has a direct link to the military; it started as a test of training and endurance for the cavalry and now has become a popular competitive sport. As a source of transportation and labor, the horse had no equal until the advent of the engine. Various breeds were developed to make horses more efficient at certain tasks: heavy draft breeds to pull enormous loads, lighter riding breeds with smooth gaits for swiftness and easy riding, small tough pony breeds to work and thrive where the living is hard, fancy-stepping elegant breeds to pull coaches and carriages, and many more.
As the need for horses in daily transportation, agriculture, and war declined, their popularity as a source of sport and recreation rose, and their former occupations were modified for pleasure and competition. The stagecoach and the delivery wagon have been replaced by competitive driving events, the military cavalry training is now 3-day eventing, and the cowboy's art with horse and rope can be seen at rodeos across the United States. Foxhunting still exists in various forms around the world, but it too has been modified into the show-ring sport of ?hunters and jumpers.? Polo is an ancient sport carried into the modern day, still a fast and furious competition. Millions of people participate in horse sports and horse-related activities each year in the United States. This can involve a pony ride at the zoo, a trail ride on a dude ranch, a horse kept in a backyard and ridden on weekends, lessons taken once or twice a week at a local stable, a serious competitor riding daily as practice for showing throughout the summer, a professional trainer riding five horses each day, a ranch hand moving livestock, or a jockey racing in several races a day. Humans have invented innumerable ways to employ and enjoy the horse, and detailing them all would fill several volumes.
The human race has been magnetically attracted to the horse throughout history. Consider the words of Xenophon in 400 bc: ?The horse is such a thing of beauty, none will tire of looking at him.? It is impossible to extinguish the passion true horsemen feel for their horse, their beauty, and the development of their prowess, and there is a spiritual cathartic process when our nature is combined with theirs (2). Riding is fundamentally a partnership between human and horse, and the satisfaction lies in the subtle communication and interaction between the two (3). The horse is a fascinating animal, combining immense power with gentleness, speed with patience, and the fear-driven instincts of a prey animal with an amazing ability to trust. Despite the inherent dangers of horse sports, millions of people climb aboard a broad back and are carried away, physically, emotionally, and spiritually. As Robert Smith Surtees put it, ?There is no secret so close as that between a rider and his horse? (4).
BIOMECHANICS, DISCIPLINES, AND DIVERSITY
This section is intended as a brief overview of the more common riding styles and horse-related activities and the factors that contribute to injuries particular to each sport.
Racing: Flat Track, Steeplechase, and Harness
Although there are many classes of races, the objective is the same: the first horse under the wire wins. A horse can run at a top speed of 40 to 45 mph, and because there are up to 12 horses in a race, the consequences of a fall can be traumatic. The potential for injury is greatest with steeplechasing, because it involves jumping 4?-foot fences, some with 6-foot ditches in front, at a 30-mph gallop (3). The horse may hit a fence and catapult the rider to the ground, or the horse may fall with or onto his rider. If the fall happens at the front of the pack, the jockey also stands a good chance of being kicked or stepped on as the rest of the horses go by. Harness races are run at a trot or pace. Although the incidence of driver injury has not been well documented, there is great potential for serious injury should a collision occur. Jockeys and drivers must wear helmets that meet or exceed standards set by the racing commissions.
Polo
Polo is a team sport, with four horses per team. It is played at a gallop, with many quick changes of direction and speed. Mallets are used to whack a small, hard ball into the goal. Riders may be injured by another's mallet or by collisions or falls. Helmets are mandatory, as are knee, knuckle, and shin protection, and facemasks are becoming commonplace (5).
Rodeo and Western Riding
In the past, early sports medicine advances in rodeo were slowed by the disregard for orthotic concerns, inadequate self-treatment, and a lack of onsite preventive care. Injury awareness is increasing, however, as is the use of taping, elbow braces, forearm padding, mouth guards, and neck braces (6).
Bronc Riding: Saddle and Bareback
The rider needs to stay on his bucking horse for 8 seconds. Bareback riders wedge a hand into rigging strapped around the horse's middle, but the horse is otherwise free. Saddle bronc riders hold a rope attached to a halter on the horse's head. In both events, the rider must keep one hand free and may not touch the horse with it at all. The legs are used in a swinging motion from the horse's shoulders to ribs and therefore cannot be used for gripping. Some riders wear neck rolls, similar to ?cowboy collars? seen in football, and the riding arm may be braced or taped. Head protection is almost never worn.
Roping and Steer Wrestling
There are several roping events in rodeo, but all involve a mounted rider or riders chasing a calf or steer, getting a rope on it, and bringing it to a standstill. In two events the rider must also dismount, grab the animal, and tie three of its legs together. There can be major trauma to the hand if it gets caught between the rope and the saddle. In steer wrestling (or bulldogging), a rider gallops after a steer, dives off the horse and onto the steer, and, by grabbing its head and horns, pulls the steer to the ground. Both are timed events. Usually no safety gear is worn other than gloves.
Barrel Racing
This is a timed event in which the rider must run a cloverleaf pattern around three barrels and back as fast as possible without knocking a barrel over. Barrel horses are typically very high energy. Because the sport mixes speed with extremely tight turns, a horse may lose its footing and fall, or the rider may cut too close to the barrel and hit it with a knee or shin. Although knee and shin guards may be worn, helmets usually are not.
Reining and Cutting
Cutting is a test of a horse's ?cow sense.? The rider selects a cow from a small group and separates it from the bunch. The horse then takes over and then must keep that cow from returning to the herd. This involves many quick starts and stops, ducks and dodges, and the rider must stay with the horse but not interfere. Reining is a sport of speed and precision that demonstrates a horse's training and handiness and the rider's accuracy in riding a figure. There are set patterns involving circles, spins, and short fast runs with sliding stops. Both cutting and reining require a rider who is well balanced on a horse and supple enough to absorb the quick changes of speed and direction. As with almost all western riding, helmets are not worn.
English Riding
Hunters and Jumpers
Both of these activities take place in an enclosed ring or arena. Riders negotiate a course of 8 to 12 jumps, up to 4? feet in height and 4 feet in width, depending on the level of competition. Each course consists of twists and turns between jumps, but jumper courses are judged on speed, making the result of a misstep more dangerous. Jumps are designed to fall apart if they are hit, and points are deducted for knocking off rails (poles). Hunters also ride in ?flat? classes, in which horses are ridden in a group and do not jump (see Miscellaneous Competition Events). A helmet must be worn for competition, but an ASTM/SEI-approved helmet is not required. In fact, because of the uncomfortable fit and unattractive appearance of most approved models, the nonapproved helmets seem to be preferred by competitors and even judges (7).
Three-Day Eventing (Combined Training)
Eventing, also called combined training, is what is seen in the Olympic Games. It is also the sport that made Christopher Reeve a quadriplegic, despite his correct and appropriate use of safety equipment. At the lower levels (horse trials or three-phase), it consists of dressage, cross-country, and stadium riding (similar to jumpers), normally run on 1 or 2 days. At the upper levels, it is run on 3 days because there are additional endurance tests for the horse and rider team. Of the three phases, cross-country has the greatest potential for injury. Depending on the level of competition, riders must gallop 1,500 to 4,000 m at speeds of 300 to 600 m per minute and tackle up to 40 jumps averaging 4 feet in height and spread. The terrain may be uneven and hilly, and the jumps are solid and designed not to fall apart if hit. Mandatory safety equipment includes a helmet, a body protector vest, and a medical armband (8).
Dressage
Dressage is to riding as figures are to skating and dance is to gymnastics. The word dressage means ?training,? and the sport involves various paces, figures, and movements executed by the horse and rider with precision and accuracy. It is sport and art combined to display the horse's full athletic potential. Although dressage does not generally involve great speed or jumping, and is usually practiced in an enclosed ring or arena, and there is still a potential for injury. Too many dressage riders do not wear helmets because they are not jumping, because they feel that their horse is ?bomb-proof,? or because they assume that they ride too well to fall off. However, horses still retain the ancient fear of a predator in the shadows, and even the best trained and seasoned horse can spook violently and unpredictably.
Driving
Driving encompasses everything from a farm horse pulling logs out of a woodlot, to an Amish buggy used for daily transport, to fancy show horses in competition in the ring, to the Budweiser Hitch. There are myriad things a horse can pull, but all driving involves the horse's overcoming the natural fear of being chased. The classic western movie scene of the runaway buckboard is a very real danger, and, apart from the driven version of eventing, drivers and their passengers very rarely wear any safety equipment at all. Although the horse and buggy may seem an anachronism in today's fast-paced world, there are small communities that still rely on the horse as their primary source of transportation. In the United States, the Amish and Mennonite drivers are most commonly seen, and as the density of automobiles increases on the roads they travel, so does the frequency of buggy-auto collisions. The large, heavy draft horses used for farm work can weigh 2,000 pounds (900 kg) and stand more than 7 feet tall (2 m) at the shoulder. Though they are normally the gentle giants of the horse world, even a minor mishap can have drastic results simply because of their size and power.
Miscellaneous Competition Events
There are so many different styles of riding and breeds of horses throughout the world that it would be impossible to touch on them all. Endurance sports are becoming popular. These may include 25- to 100-mile endurance rides, ?ride and tie? competitions, the modern pentathlon, and even the new EcoChallenge. These events test the horses' conditioning as well as the riders' fitness and horsemanship. There are many kinds of riding competitions that are judged as ?rail classes??that is, a group of horses are ridden at various gaits, with the judging emphasizing everything from the rider's ability to the horse's way of going. In two disciplines in particular, western riding and saddleseat, riders classically do not wear helmets in competition, not even small children. Although one would think that competitions would be designed to prove whose horse is faster or better trained, or which rider is the most skilled, many horse shows have become nothing but beauty pageants, and fashion often counts for more than safety and common sense.
Recreational Activities
The most common use of the horse today is for individual pleasure and recreation. The casual weekend rider, the child taking weekly lessons at a local stable, and the backyard horse owner probably make up the majority of the ridership in the United States. Unfortunately it is just this population that is hardest to quantify in terms of injury rates and? with the possible exception of the lesson-taking child?impossible to regulate in terms of safety. Even those riders who must compete in a helmet might not do so at home or in practice, and because many people who keep a horse just for trail riding also ride western, there is little incentive to wear a helmet.
EPIDEMIOLOGY
To begin this section one should keep in mind that equine sports have been considered dangerous since ancient times, to wit the old Arab proverb: ?The grave yawns for the horseman? (9). The horse is a massive animal, weighing 1,000 to 1,500 pounds (500 to 680 kg) or more, that can travel with a rider at 30 mph (50 kph) or more (10,11). With the average saddle height at 6? feet (2 m) and the rider's head height at almost 10 feet (3 m) (12), a fall is a dynamic event unrivaled in nonmotorized recreational sport. The force of a kick, supplied through a steel-shod hoof, exceeds 10 kN (13). Because of such large forces involved, equestrian injuries should be initially considered ?ballistic? or high-energy injuries. Indeed, in some studies, horse trials have a higher rate of injury and death than motorcycle racing (5,14).
In the United States, horseback riding is an extremely popular sport. Approximately 30 million people ride at least once a year, and at least half of them ride on regular basis (15,16 and 17). The U.K. riding community exceeds 3 million, half of whom are children (18). In 1990, the U.S. Centers for Disease Control and Prevention (CDC) estimated the incidence of horse-related injuries to be 18.7 per 100,000 (19). Although the various riding disciplines have some differences in their injury statistics, use of the National Electronic Injury Surveillance System (NEISS) database revealed that in 1987?1988 there were an estimated 92,763 emergency room visits relate to riding. Between 45% and 75% of the injuries resulted when the rider fell from the horse (12,15,17,20).
Because of wide variation in the way horses are used for sport and pleasure and the different reporting systems (from discipline or professional society reviews to emergency room reports), a review of the literature can paint quite a confusing picture. However, such a review clearly documents the hazards of riding (17,21,22,23,24,25,26,27 and 28) and on closer inspection does reveal some basic patterns.
Age
The American Horse Council estimated that 258,434 youths were involved in 4-H horse and pony programs in 1994 and 13,000 youths were members of United States Pony Clubs (29). Earlier the same organization estimated there were 1.2 million horse owners in the United States who were younger than 20 years of age (30). In 1985, Hammett noted that ?in the two-year study of the estimated 13,428,000 hours of horse activity by 18,408 U.S. Pony Club members age 6 to 21 in scheduled supervised programs, there were 64 accidents resulting in 88 injuries? (31).
In 1996 a review of the United States NEISS database showed that approximately 25,000 emergency department visits were made by individuals younger than 25 years of age as a result of horse-related injuries (32). Approximately 2,300 of these patients were admitted to the hospital (33). The total cost of these horse-related injuries was estimated at more than $88 million, and the average cost per injury at $7,400 (34).
When data from worldwide studies of horse-related injuries by age group are reviewed for both pediatric (USPC, VISS) (35,36,37 and 38) and all ages (NEISS, CHIRPP) (39), two peaks become clear (Fig. 22.1). The first peak is the 10- to 14-year-old age group (20.2% to 48.1% of participants injured), and the second peak is the 25- to 40-year-old age group (13.1% to 39.6% injured). Although it is difficult to compare data from such varied studies, these results are certainly consistent with the overall trend seen in the literature.

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